Board of Dental Examiners Changes to Application Process: PBIS Closure Due to the closure of Professional Background Information Services (PBIS) as of November 16, 2020, all items that would normally be submitted through PBIS must now be submitted directly to the division. Please see the appropriate checklist for the application with which you are submitting. Please contact the licensing examiner with any questions: BoardOfDentalExaminers@Alaska.Gov INITIAL Applications Dentist Applications Dental License Application #08-4159, Revised 02/24/2022 Permit to Administer Moderate Sedation Application #08-4172, Revised 12/12/2018 Permit to Administer Deep Sedation or General Anesthesia Application #08-4618, Revised 04/01/2018 Dentist or Dental Hygienist Courtesy License Application #08-0005, Revised 02/24/2022 Notification of Sedation Agreement #08-4749, Revised 04/01/2018 Temporary Dental Permit Application #08-4789, Revised 02/24/2022 Hygienist Applications Application for Dental Hygiene License #08-0075, Revised 02/16/2021 Application for Certificate to Administer Local Anesthetic Agent #08-0073, Revised 04/01/2018 Dental Hygiene Restorative Function Endorsement Application #08-4567, Revised 01/13/2017 Dental Hygiene Collaborative Agreement Application #08-4542, Revised 05/10/2013 Application for a Courtesy License to Practice Dentistry or Dental Hygiene #08-0005, Revised 12/19/2013 Dental Hygiene Nitrous Oxide Certificate Application #08-4748, Revised 03/21/2018 Dental Assistant Applications Application for Certification to Perform Coronal Polishing #08-4561, Revised 01/30/2015 Application for Certification to Perform Restorative Functions #08-4577, Revised 01/30/2015 RENEWAL Applications Biennial Dental License Renewal #08-4132, Revised 12/20/2020 Biennial Dental Hygiene License Renewal #08-4063, Revised 12/20/2020 Dental Hygiene Restorative Function Biennial Certificate Renewal #08-4609, Revised 12/20/2020 Dental Assistant Coronal Polishing Biennial Certificate Renewal #08-4610, Revised 12/20/2020 Moderate Sedation Permit Renewal #08-4780, Revised 12/20/2020 Deep Sedation and General Anesthesia Permit Renewal #08-4781, Revised 12/20/2020 Dental Assistant Restorative Function Certificate Renewal #08-4784, Revised 12/20/2020 Radiological Equipment Applications Radiological Equipment Registration Form #08-4420, Revised 02/2014 Inspection of Dental Radiological Equipment Form #08-4413, Revised 02/2014 Miscellaneous Forms Sedation Checklist for the Dental Office#08-4775, New 06/11/2020 Continuing Education Course Approval Application #08-4241, Revised 02/17/2017 Coronal Polishing Course Approval Application#08-4762, New 04/01/2018 Nitrous Oxide Course Approval Application#08-4774, New 04/01/2018 Clinical Program Approval Application#08-4608, Revised 05/29/2012 Division forms may be found in the CBPL Quick links, located in the sidebar to the right.